Effective education should generate long-term improvements in physicians' knowledge and practice patterns, not just short-term gains that quickly dissipate over time. Current methods of education often do not achieve this end. By clumping education into ‘bolus’ learning events without subsequent reinforcement, much of the material learned at lectures, seminars, hands-on practice sessions, and board-review courses will be quickly forgotten. This is not the fault of the learner—forgetting is a well-studied, natural physiological process that should be expected.
Applicants have found that a new form of online education (termed in the art ‘spaced education’) that can substantially improve long-term retention of learning. Spaced education courses consist of a series of questions and explanations that are presented to learners via email on computers and mobile devices. Based on each learner's performance, the spacing, reinforcement, and content of the subsequent material adapts for that individual until mastery of the content is achieved.
Spaced education is based on two core psychology research findings, the spacing and testing effects. The ‘spacing effect’ refers to the finding that information which is presented and repeated over spaced intervals is learned and retained more efficiently than information presented at a single time-point. The spacing effect appears to have a distinct neurophysiologic basis. A protein tyrosinephosphatase has been identified which regulates the spacing effect in Drosophila (Pagani, M. R., Oishi K., Gelb, B. D. et al.: The Phosphatase SHP2 regulates the spacing effect for long-term memory induction. Cell, 139: 189, 2009). In addition, spaced learning by rats was found to improve neuronal longevity in the hippocampus (a primary memory center in the brain). See Sisti, H. M., Glass, A. L., Shors, T. J.: Neurogenesis and the spacing effect: Learning over time enhances memory and the survival of new neurons. Learn Mem, 14: 368, 2007. By presenting material in a question-answer testing format, spaced education also harnesses the educational merits of the ‘testing effect’. The ‘testing effect’ refers to the psychological finding that the process of testing does not merely assess the knowledge levels of individuals. Rather, testing alters the learning process itself so that new knowledge is retained more effectively (Karpicke, J. D., Roediger, H. L., 3rd: The critical importance of retrieval for learning. Science, 319: 966, 2008).
To date, more than 10 large randomized trials have been conducted to show that spaced education improves knowledge acquisition, (Kerfoot, B. P., Kearney, M. C., Connelly, D. et al.: Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial. Ann Surg, 249: 744, 2009) boosts learners' abilities to self-assess their performance, and improves knowledge retention (Kerfoot, B. P.: Learning benefits of on-line spaced education persist for 2 years, J Urol, 181: 2671, 2009). In one trial of 1067 medical students at 4 medical schools, spaced education increased longer-term retention by 170%. In another with 95 clinicians at 8 medical centers, spaced education reduced inappropriate prostate cancer screening by 40% for more than a year after the intervention. In a trial of 724 urology residents across the US, spaced education improved long-term learning efficiency 4-fold and was preferred 3:1 over web-based teaching modules.
Spaced education to date has utilized question types of the following formats: multiple-choice question (single correct answer), multiple correct answer, and fill-in-the-blank. These question formats are appropriate for questions that have a correct answer, but many important questions (e.g. in the fields of ethics, politics, religion, etc) do not have distinct correct answers. Given this, a new question format is needed that can accommodate a range of potential answers without the need for there to be a correct answer designated by the question writer. Applicants hypothesize that free-text question format would be ideal since it could capture a broad range of nuanced responses. Psychological research on the testing effect has also shown that questions utilizing non-cued free-text responses generate greater long-term retention of knowledge than cued-response question formats (Kang, S. H. K., McDermott, K. B., Roediger, H. L.: Test format and corrective feedback modify the effect of testing on long-term retention. European Journal of Cognitive Psychology, 19 528, 2007).